East/West Approaches to Respiratory Health, Part 1

"No two people are exactly alike. As true physicians, we must remember this, and note carefully the characteristic types of patients and their peculiar temperaments."

- Dr.

Edward Shook,Advanced Treatise in Herbology

Clinicians and students in a TCM clinic know all too well that patients rarely choose TCM as their first line of treatment. All too often, clinicians are presented with chronic, lingering disorders that have not responded to allopathic and other treatments. Respiratory disorders commonly fall into this category. In this series of articles, I will examine ways to integrate Western, Chinese and ayurvedic medicinals in a manner consistent with TCM diagnostic methodology, to more effectively treat chronic respiratory ailments and help patients recover from the potential iatrogenic effects of allopathic medications. I also will dispel some common misconceptions concerning traditional Western herbalism, discuss TCM medicinal mushrooms useful in chronic respiratory disorders, and present unique ayurvedic therapies that can complement any type of allopathic or integrative therapy for the respiratory system.

One of the most common misconceptions I would like to challenge is the idea that Western herbalism is primarily an allopathic herbalism which lacks a differential diagnostic system and only uses single medicinals as its modality of choice. It is easy to see how this idea has taken shape when one examines the shelves of a local health food store and sees rows and rows of "headache" herbs or "menopause" herbs, none of which addresses the unique expressions of the individual patient. However, if one looks back to the source texts in Western herbalism, a vastly different picture emerges.

For any system of medicine to grow and evolve, it must have a stable foundation to look back upon as it moves forward. The source texts of TCM and ayurveda are consistently cited to defend, critique or create new theories and evolutions in their perspective systems. Yet when one reads articles or texts discussing Western herbalism, the works cited are typically modern scientific studies and best-selling books rarely written by practicing clinical herbalists. To truly understand and integrate Western herbs into a highly refined system of traditional medicine such as TCM or ayurveda, one must be familiar with source texts in the Western tradition such as King's American Dispensatory by Felter and Lloyd or Advanced Treatise in Herbology by Edward Shook. I will use these two source texts to discuss ways to potentially integrate two Western medicinals, mullein (Verbascum thapsus) and lobelia (Lobelia inflata), with TCM formulas for chronic respiratory issues.

Mullein leaves and flowers have long been used in Western herbalism to allay respiratory issues of both a chronic and acute nature. King's American Dispensatory describes mullein as the following: demulcent, antispasmodic and mildly nervine; useful with nervous agitation; its action is directed to the upper part of the respiratory tract; useful in coughs, protracted colds, bronchial irritation, catarrh (phlegm), hemoptysis, diarrhea, dysentery and piles; and its specific indications are dry, hoarse coughs that occur chiefly at night, as well as coughs with abundant catarrhal discharge.

What does this information tell us in TCM rubric? I believe it hints that mullein can mildly supplement yin, clear mild Vacuity heat, transform phlegm, and perhaps invigorate Blood. It also seems to suggest a Lung/Large Intestine connection when referencing specific intestinal issues along with respiratory problems. With this in mind we might easily and intelligently add mullein to such TCM formulas as bai he gu jin wan to help assist supplementation of Lung yin and transform phlegm. Or we could perhaps incorporate it into a formula such as sheng mai san where a protracted respiratory disorder has damaged both Lung qi and yin. I have effectively used variations of sheng mai san, adding mullein and tai zi shen for chronic, lingering Lung issues that continue to worsen following antibiotic therapy, modified accordingly to each patient's pattern. When one references mullein in Advanced Treatise in Herbology, Shook lists several formulas combinations modified according to the needs of the patient and states, "one single herb, no matter how good that might be for a specific condition, is sometimes not adequate to take care of all conditions that exist."

Lobelia is another Western medicinal that has a vast potential to be used concomitantly with TCM formulas. King's American Dispensatory lists the following indications for lobelia: dry, barking coughs and all forms of irritation of the respiratory tract with oppression; it relaxes the tissues (allowing blood to move) and favors expectoration when a large quantity of mucus is secreted and there is want of power to remove it; specific pulse indications are full, labored doughy pulse or a small, feeble pulse; tongue indications are heavy and sticky coating especially at the base.

What does this indicate in TCM verbiage? Perhaps that lobelia can invigorate Blood, transform and expel phlegm and act as a guiding medicinal to the Lungs. The dosing of lobelia was very small, 1-10 drops, and was used in larger doses as an emetic to expel phlegm from the Lungs and Stomach and calm respiratory spasms. I often use small doses of lobelia, 1-5 drops, with TCM formulas to guide the herbs to the Lungs, especially if the tongue is sticky and coated, the pulse is slippery (doughy) or choppy (small, feeble), and the chronic cough is causing pain in the chest cavity. This also suggests a connection between the traditional use of dang gui in stopping coughs, as lobelia is used in scenarios in which "the blood moves with difficulty." Perhaps Blood stasis medicinals can be used as adjunctive therapies in chronic respiratory scenarios.

I hope this short discussion using source texts has both enlightened and intrigued you. Much work is left to be done to discover the information in these long-forgotten and widely underused Western texts. The Western herbalist Michael Moore has done an amazing service cataloguing many of these texts on his Web site for the Southwest School for Botanical Medicine (www.swsbm.com). I highly recommend readers visit this site for more information on these historic Western sources. In doing so, we can contribute to the evolution of true integrative herbalism. In my next article, I will discuss the use of the medicinal mushrooms reishi and cordyceps in chronic respiratory disorders. Until then, take care and Namaskar.

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